Provider Demographics
NPI:1245494434
Name:RAD GROUP INC.
Entity type:Organization
Organization Name:RAD GROUP INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:RANDA
Authorized Official - Middle Name:SAMI
Authorized Official - Last Name:AMMSSO
Authorized Official - Suffix:
Authorized Official - Credentials:ABO
Authorized Official - Phone:925-964-1010
Mailing Address - Street 1:11000 BOLLINGER CANYON RD # C
Mailing Address - Street 2:
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94582-4959
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11000 BOLLINGER CANYON RD # C
Practice Address - Street 2:
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94582-4959
Practice Address - Country:US
Practice Address - Phone:925-964-1010
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SITE FOR SORE EYES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-07-16
Last Update Date:2008-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA177242156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty